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OTHERINSURANCEINFORMATIONSURVEY SPOUSE/DOMESTICPARTNERMail:P.O. Box4100Concord,CA945244100 Telephone:(800)5522400 Facsimile:(925)7467549 www.ufcwtrust.comINSTRUCTIONS SECTION 1PleasereadandcompleteallinformationasitisapplicabletoyourSpouse/DomesticPartnerregardinginsuranceotherthanyourUFCWTrustFundinsurance.MEMBER/PARTICIPANT
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Provide the necessary information about the spouse or dependent for whom the verification is required. This can include their name, relationship to you, and any other relevant details.
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20170320spouse-dp oii dependent verification is a form used to verify the dependent status for spouses and children of individuals covered under the OII plan.
All individuals covered under the OII plan who have dependents must file the 20170320spouse-dp oii dependent verification form.
You can fill out the 20170320spouse-dp oii dependent verification form online or by mail, providing accurate information about your dependents.
The purpose of 20170320spouse-dp oii dependent verification is to ensure that only eligible dependents are covered under the OII plan.
You must report the names, ages, relationships, and dependent status of all individuals you are claiming as dependents.
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